|
REMOVAL OF FOOT LESION
|
Facility
|
IP
|
$7,454.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
5102809001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,516.71 |
| Max. Negotiated Rate |
$7,081.30 |
| Rate for Payer: Aetna of VT Commercial |
$7,081.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,516.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,516.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,335.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,261.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,963.20
|
| Rate for Payer: Cash Price |
$3,727.00
|
| Rate for Payer: Cigna Commercial |
$5,963.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,963.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,963.20
|
| Rate for Payer: Multiplan Commercial |
$6,932.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,335.90
|
| Rate for Payer: United Healthcare Commercial |
$7,081.30
|
|
|
REMOVAL OF FOOT LESION
|
Professional
|
Both
|
$1,255.00
|
|
|
Service Code
|
CPT 28080
|
| Hospital Charge Code |
9822808001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$368.76 |
| Max. Negotiated Rate |
$1,179.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,179.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,124.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$379.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,124.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$516.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$644.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$644.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$424.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$644.88
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cigna Commercial |
$692.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$830.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$830.59
|
| Rate for Payer: Martins Point Health Care Commercial |
$511.70
|
| Rate for Payer: Multiplan Commercial |
$1,167.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$523.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$368.76
|
| Rate for Payer: United Healthcare Commercial |
$567.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$368.76
|
| Rate for Payer: United Healthcare VA CCN |
$368.76
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
CPT 28080
|
| Hospital Charge Code |
9822808001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$555.84 |
| Max. Negotiated Rate |
$1,192.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,192.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,124.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$555.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,124.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$755.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,066.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,016.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$564.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$997.73
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cigna Commercial |
$1,004.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,004.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,004.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$564.75
|
| Rate for Payer: Multiplan Commercial |
$1,167.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,066.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$564.75
|
| Rate for Payer: United Healthcare Commercial |
$1,192.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$564.75
|
| Rate for Payer: United Healthcare VA CCN |
$564.75
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
OP
|
$7,454.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
5102809001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,301.38 |
| Max. Negotiated Rate |
$7,081.30 |
| Rate for Payer: Aetna of VT Commercial |
$7,081.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,678.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,301.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,678.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,487.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,335.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,037.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,354.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,925.93
|
| Rate for Payer: Cash Price |
$3,727.00
|
| Rate for Payer: Cigna Commercial |
$5,963.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,963.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,963.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,354.30
|
| Rate for Payer: Multiplan Commercial |
$6,932.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,335.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,354.30
|
| Rate for Payer: United Healthcare Commercial |
$7,081.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,354.30
|
| Rate for Payer: United Healthcare VA CCN |
$3,354.30
|
|
|
REMOVAL OF FOOT LESION
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
9822809001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$297.04 |
| Max. Negotiated Rate |
$1,061.26 |
| Rate for Payer: Aetna of VT Commercial |
$1,061.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,011.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$305.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,011.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$415.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$600.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$600.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$341.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$600.40
|
| Rate for Payer: Cash Price |
$564.50
|
| Rate for Payer: Cash Price |
$564.50
|
| Rate for Payer: Cigna Commercial |
$562.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$716.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$716.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$440.94
|
| Rate for Payer: Multiplan Commercial |
$1,049.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$421.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$297.04
|
| Rate for Payer: United Healthcare Commercial |
$456.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$297.04
|
| Rate for Payer: United Healthcare VA CCN |
$297.04
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
OP
|
$1,129.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
9822809001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$500.03 |
| Max. Negotiated Rate |
$1,072.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,072.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,011.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$500.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,011.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$679.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$959.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$914.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$508.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$897.55
|
| Rate for Payer: Cash Price |
$564.50
|
| Rate for Payer: Cigna Commercial |
$903.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$903.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$903.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$508.05
|
| Rate for Payer: Multiplan Commercial |
$1,049.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$959.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$508.05
|
| Rate for Payer: United Healthcare Commercial |
$1,072.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$508.05
|
| Rate for Payer: United Healthcare VA CCN |
$508.05
|
|
|
REMOVAL OF FOOT LESION
|
Professional
|
Both
|
$1,953.00
|
|
|
Service Code
|
CPT 28104
|
| Hospital Charge Code |
9822810401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$341.62 |
| Max. Negotiated Rate |
$1,835.82 |
| Rate for Payer: Aetna of VT Commercial |
$1,835.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,749.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$351.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,749.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$478.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$713.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$713.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$392.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$713.13
|
| Rate for Payer: Cash Price |
$976.50
|
| Rate for Payer: Cash Price |
$976.50
|
| Rate for Payer: Cigna Commercial |
$643.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$814.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$814.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$500.29
|
| Rate for Payer: Multiplan Commercial |
$1,816.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$485.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$341.62
|
| Rate for Payer: United Healthcare Commercial |
$525.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$341.62
|
| Rate for Payer: United Healthcare VA CCN |
$341.62
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
IP
|
$1,953.00
|
|
|
Service Code
|
CPT 28104
|
| Hospital Charge Code |
9822810401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,445.42 |
| Max. Negotiated Rate |
$1,855.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,855.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,445.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,445.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,660.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,640.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,562.40
|
| Rate for Payer: Cash Price |
$976.50
|
| Rate for Payer: Cigna Commercial |
$1,562.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,562.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,562.40
|
| Rate for Payer: Multiplan Commercial |
$1,816.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,660.05
|
| Rate for Payer: United Healthcare Commercial |
$1,855.35
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
OP
|
$1,129.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
9602809002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$500.03 |
| Max. Negotiated Rate |
$1,072.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,072.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,011.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$500.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,011.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$679.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$959.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$914.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$508.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$897.55
|
| Rate for Payer: Cash Price |
$564.50
|
| Rate for Payer: Cigna Commercial |
$903.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$903.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$903.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$508.05
|
| Rate for Payer: Multiplan Commercial |
$1,049.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$959.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$508.05
|
| Rate for Payer: United Healthcare Commercial |
$1,072.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$508.05
|
| Rate for Payer: United Healthcare VA CCN |
$508.05
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
IP
|
$8,582.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
9602809001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$6,351.54 |
| Max. Negotiated Rate |
$8,152.90 |
| Rate for Payer: Aetna of VT Commercial |
$8,152.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,351.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,351.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7,294.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,208.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,865.60
|
| Rate for Payer: Cash Price |
$4,291.00
|
| Rate for Payer: Cigna Commercial |
$6,865.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,865.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,865.60
|
| Rate for Payer: Multiplan Commercial |
$7,981.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,294.70
|
| Rate for Payer: United Healthcare Commercial |
$8,152.90
|
|
|
REMOVAL OF FOOT LESION
|
Professional
|
Both
|
$8,582.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
9602809001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$297.04 |
| Max. Negotiated Rate |
$8,067.08 |
| Rate for Payer: Aetna of VT Commercial |
$8,067.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7,688.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$305.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7,688.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$415.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$600.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$600.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$341.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$600.40
|
| Rate for Payer: Cash Price |
$4,291.00
|
| Rate for Payer: Cash Price |
$4,291.00
|
| Rate for Payer: Cigna Commercial |
$562.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$716.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$716.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$440.94
|
| Rate for Payer: Multiplan Commercial |
$7,981.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$421.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$297.04
|
| Rate for Payer: United Healthcare Commercial |
$456.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$297.04
|
| Rate for Payer: United Healthcare VA CCN |
$297.04
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
IP
|
$1,129.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
9602809002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$835.57 |
| Max. Negotiated Rate |
$1,072.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,072.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$835.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$835.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$959.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$948.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$903.20
|
| Rate for Payer: Cash Price |
$564.50
|
| Rate for Payer: Cigna Commercial |
$903.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$903.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$903.20
|
| Rate for Payer: Multiplan Commercial |
$1,049.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$959.65
|
| Rate for Payer: United Healthcare Commercial |
$1,072.55
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
OP
|
$8,582.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
9602809001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,800.97 |
| Max. Negotiated Rate |
$8,152.90 |
| Rate for Payer: Aetna of VT Commercial |
$8,152.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7,688.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,800.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7,688.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5,166.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7,294.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,951.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,861.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,822.69
|
| Rate for Payer: Cash Price |
$4,291.00
|
| Rate for Payer: Cigna Commercial |
$6,865.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,865.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,865.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,861.90
|
| Rate for Payer: Multiplan Commercial |
$7,981.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,294.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,861.90
|
| Rate for Payer: United Healthcare Commercial |
$8,152.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,861.90
|
| Rate for Payer: United Healthcare VA CCN |
$3,861.90
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
CPT 28080
|
| Hospital Charge Code |
9822808001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$928.83 |
| Max. Negotiated Rate |
$1,192.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,192.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$928.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$928.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,066.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,054.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,004.00
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cigna Commercial |
$1,004.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,004.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,004.00
|
| Rate for Payer: Multiplan Commercial |
$1,167.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,066.75
|
| Rate for Payer: United Healthcare Commercial |
$1,192.25
|
|
|
REMOVAL OF FOREIGN BODY
|
Facility
|
IP
|
$1,744.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
9822737201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,290.73 |
| Max. Negotiated Rate |
$1,656.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,656.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,290.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,290.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,482.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,464.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,395.20
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cigna Commercial |
$1,395.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,395.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,395.20
|
| Rate for Payer: Multiplan Commercial |
$1,621.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,482.40
|
| Rate for Payer: United Healthcare Commercial |
$1,656.80
|
|
|
REMOVAL OF FOREIGN BODY
|
Professional
|
Both
|
$4,496.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
9602052501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$233.64 |
| Max. Negotiated Rate |
$4,226.24 |
| Rate for Payer: Aetna of VT Commercial |
$4,226.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,027.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$240.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,027.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$327.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$606.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$606.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$268.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$606.26
|
| Rate for Payer: Cash Price |
$2,248.00
|
| Rate for Payer: Cash Price |
$2,248.00
|
| Rate for Payer: Cigna Commercial |
$439.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$719.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$719.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$439.85
|
| Rate for Payer: Multiplan Commercial |
$4,181.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$331.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$233.64
|
| Rate for Payer: United Healthcare Commercial |
$359.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.64
|
| Rate for Payer: United Healthcare VA CCN |
$233.64
|
|
|
REMOVAL OF FOREIGN BODY
|
Professional
|
Both
|
$1,744.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
9822737201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$381.10 |
| Max. Negotiated Rate |
$1,639.36 |
| Rate for Payer: Aetna of VT Commercial |
$1,639.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,562.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$392.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,562.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$533.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$787.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$787.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$438.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$787.01
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cigna Commercial |
$717.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$913.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$913.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$555.52
|
| Rate for Payer: Multiplan Commercial |
$1,621.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$541.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$381.10
|
| Rate for Payer: United Healthcare Commercial |
$586.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.10
|
| Rate for Payer: United Healthcare VA CCN |
$381.10
|
|
|
REMOVAL OF FOREIGN BODY
|
Facility
|
OP
|
$1,744.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
9822737201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$772.42 |
| Max. Negotiated Rate |
$1,656.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,656.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,562.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$772.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,562.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,049.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,482.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,412.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$784.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,386.48
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cigna Commercial |
$1,395.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,395.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,395.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$784.80
|
| Rate for Payer: Multiplan Commercial |
$1,621.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,482.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$784.80
|
| Rate for Payer: United Healthcare Commercial |
$1,656.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$784.80
|
| Rate for Payer: United Healthcare VA CCN |
$784.80
|
|
|
REMOVAL OF FOREIGN BODY
|
Facility
|
IP
|
$4,496.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
9602052501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,327.49 |
| Max. Negotiated Rate |
$4,271.20 |
| Rate for Payer: Aetna of VT Commercial |
$4,271.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,327.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,327.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,821.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,776.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,596.80
|
| Rate for Payer: Cash Price |
$2,248.00
|
| Rate for Payer: Cigna Commercial |
$3,596.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,596.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,596.80
|
| Rate for Payer: Multiplan Commercial |
$4,181.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,821.60
|
| Rate for Payer: United Healthcare Commercial |
$4,271.20
|
|
|
REMOVAL OF FOREIGN BODY
|
Facility
|
OP
|
$1,097.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
9602052502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$485.86 |
| Max. Negotiated Rate |
$1,042.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,042.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$982.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$485.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$982.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$660.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$932.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$888.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$493.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$872.12
|
| Rate for Payer: Cash Price |
$548.50
|
| Rate for Payer: Cigna Commercial |
$877.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$877.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$877.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$493.65
|
| Rate for Payer: Multiplan Commercial |
$1,020.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$932.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$493.65
|
| Rate for Payer: United Healthcare Commercial |
$1,042.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$493.65
|
| Rate for Payer: United Healthcare VA CCN |
$493.65
|
|
|
REMOVAL OF FOREIGN BODY
|
Facility
|
IP
|
$3,399.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
5102052501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,515.60 |
| Max. Negotiated Rate |
$3,229.05 |
| Rate for Payer: Aetna of VT Commercial |
$3,229.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,515.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,515.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,889.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,855.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,719.20
|
| Rate for Payer: Cash Price |
$1,699.50
|
| Rate for Payer: Cigna Commercial |
$2,719.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,719.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,719.20
|
| Rate for Payer: Multiplan Commercial |
$3,161.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,889.15
|
| Rate for Payer: United Healthcare Commercial |
$3,229.05
|
|
|
REMOVAL OF FOREIGN BODY
|
Professional
|
Both
|
$1,097.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
9602052502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$233.64 |
| Max. Negotiated Rate |
$1,031.18 |
| Rate for Payer: Aetna of VT Commercial |
$1,031.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$982.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$240.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$982.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$327.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$606.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$606.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$268.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$606.26
|
| Rate for Payer: Cash Price |
$548.50
|
| Rate for Payer: Cash Price |
$548.50
|
| Rate for Payer: Cigna Commercial |
$439.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$719.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$719.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$439.85
|
| Rate for Payer: Multiplan Commercial |
$1,020.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$331.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$233.64
|
| Rate for Payer: United Healthcare Commercial |
$359.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.64
|
| Rate for Payer: United Healthcare VA CCN |
$233.64
|
|
|
REMOVAL OF FOREIGN BODY
|
Facility
|
OP
|
$3,399.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
5102052501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,505.42 |
| Max. Negotiated Rate |
$3,229.05 |
| Rate for Payer: Aetna of VT Commercial |
$3,229.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,045.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,505.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,045.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,046.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,889.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,753.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,529.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,702.20
|
| Rate for Payer: Cash Price |
$1,699.50
|
| Rate for Payer: Cigna Commercial |
$2,719.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,719.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,719.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,529.55
|
| Rate for Payer: Multiplan Commercial |
$3,161.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,889.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,529.55
|
| Rate for Payer: United Healthcare Commercial |
$3,229.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,529.55
|
| Rate for Payer: United Healthcare VA CCN |
$1,529.55
|
|
|
REMOVAL OF FOREIGN BODY
|
Facility
|
OP
|
$4,496.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
9602052501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,991.28 |
| Max. Negotiated Rate |
$4,271.20 |
| Rate for Payer: Aetna of VT Commercial |
$4,271.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,027.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,991.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,027.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,706.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,821.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,641.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,023.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,574.32
|
| Rate for Payer: Cash Price |
$2,248.00
|
| Rate for Payer: Cigna Commercial |
$3,596.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,596.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,596.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,023.20
|
| Rate for Payer: Multiplan Commercial |
$4,181.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,821.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,023.20
|
| Rate for Payer: United Healthcare Commercial |
$4,271.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,023.20
|
| Rate for Payer: United Healthcare VA CCN |
$2,023.20
|
|
|
REMOVAL OF FOREIGN BODY
|
Professional
|
Both
|
$3,399.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
5102052501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.64 |
| Max. Negotiated Rate |
$3,195.06 |
| Rate for Payer: Aetna of VT Commercial |
$3,195.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,045.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$240.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,045.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$327.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$606.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$606.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$268.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$606.26
|
| Rate for Payer: Cash Price |
$1,699.50
|
| Rate for Payer: Cash Price |
$1,699.50
|
| Rate for Payer: Cigna Commercial |
$439.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$719.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$719.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$439.85
|
| Rate for Payer: Multiplan Commercial |
$3,161.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$331.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$233.64
|
| Rate for Payer: United Healthcare Commercial |
$359.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.64
|
| Rate for Payer: United Healthcare VA CCN |
$233.64
|
|
